MEDICARE: DR. JASON CARNES LEWIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	42621	KY
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	01072411A	IN
3	208VP0014X	Interventional Pain Medicine Physician	42621	KY
4	207LP2900X	Pain Medicine (Anesthesiology) Physician	42621	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	84129KYIP	OTHER	KY	AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
3	961015	OTHER	KY	WELLCARE OF KY PROVIDER ID NUMBER
4	005625439	OTHER		UNITED HEALTHCARE PROVIDER ID NUMBER
5	CS1425100206	OTHER		CARESOURCE PROVIDER ID NUMBER
6	9497399	OTHER		AETNA PIN NUMBER
7	000000825810	OTHER		ANTHEM PROVIDER ID NUMBER
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720127913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON CARNES LEWIS MD

Provider Business Mailing Address
First Line	:	PO BOX 21890
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4115
Country	:	US
Telephone Number	:	502-907-0356
Fax Number	:	502-907-0356

Provider Business Practice Location Address
First Line	:	222 S 1ST ST
Second Line	:	SUITE 300
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-5404
Country	:	US
Telephone Number	:	502-855-3919
Fax Number	:	502-855-3920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	09/12/2024

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